Infant Brain Injury

Infant Brain Injury Lawyers

Infant brain injuries are brain injuries that a child sustains during birth and delivery or in the neonatal period. These injuries are often due to medical negligence or malpractice, as many of them occur when a doctor deviates from accepted “standards of care.” These usually result in some form of disability (ranging from mild to severe), because brain injuries in developing children disrupt the proper formation of brain structures. This can have a global, long-term impact on a child’s ability to perform the Activities of Daily Living (ADLs).

Anatomy and Function Of A Baby’s Brain

Overview

The outer part of the brain is made up of rounded ridges called gyri. Each individual gyrus is separated by grooves called fissures or sulci. Some of the sulci are very pronounced and serve as boundaries between the 4 lobes of the brain.

The 3 major parts of the brain include:

The Cerebellum

The cerebellum is a continuous thin layer of tissue that is tightly folded. It also sits on top of a lot of white matter. Within the cerebellum’s thin layers are many different types of neurons that form a complex network that have massive signal-producing capability. The cerebellum plays a major role in motor control (muscle control). This part of the brain does not initiate movement, but it greatly contributes to coordination of muscle movement, balance, timing and precision. The cerebellum controls a child’s sense of position, called proprioconception. A serious injury to the cerebellum can greatly affect a child’s ability to know where her arms and legs are in space. In addition, damage to this part of the brain can affect a child’s ability to walk, run, and have balance and normal muscle tone, as well as the ability to use fine motor function, such as holding a piece of cereal. The cerebellum is also involved in some cognitive functions, such as language and attention.

The Cerebrum

This is the largest part the brain. The cerebrum’s nerve centers control movement, cognition, reasoning, memory, perception, judgment and decision-making. The surface of the cerebrum is called the cerebral cortex. The cerebral cortex consists of 6 layers of neurons. Neurons are very important brain cells that process and transmit information via electrical and chemical signals, and they connect to each other and form the core of the nervous system. The layers of neurons sit on top of a large amount of the brain’s white matter. White matter helps transmit messages throughout the largest parts of the brain.

The Brain Stem

The brain stem plays a major role in regulating essential bodily functions, such as breathing, heart rate and blood pressure. It is also involved in relaying information from the cerebrum and cerebellum to the rest of the body through the spinal cord.

The 2 parts of the cerebrum are known as cerebral hemispheres. The corpus callosum connects these hemispheres so the left and right sides of the brain can communicate.

Major Lobes of the Brain in the Cerebrum

Frontal Lobe

The lobe of the brain that is the furthest forward is called the frontal lobe. This lobe is very important because it is responsible for voluntary movement and planning and researchers think it is the most important lobe for intelligence and personality. Some specific functions associated with the frontal lobe are coordinated movement, abstract thought, problem-solving, creative thought, judgment and emotion.

The motor cortex controls motor function and is located in the frontal lobe. The lowest portions of the motor cortex control the muscles of the face and mouth. The parts of the motor cortex near the top of the head control the legs and feet.

Parietal Lobe

This lobe is behind the frontal lobe and contains the somatosensory cortex. The parietal lobe is responsible for feeling touch on certain parts of the body. For example, the part of the parietal lobe closest to the temples is responsible for feeling touch on the mouth and face and the part of the lobe closest to the top of the head is responsible for feeling touch on the legs and feet. Specific functions associated with the parietal lobe include comprehension of pain, pressure, heat, cold and touch, as well as an appreciation of form.

Temporal Lobe

The lobe of the brain at the side of the head is called the temporal lobe. An important part of this lobe is the auditory cortex, which is connected with the ears and plays a major role in hearing. Specific functions associated with the temporal lobe include hearing, memories, and fear, as well as some speech and language behavior.

Occipital Lobe

This lobe is at the back of the head and it contains the visual cortex, which receives information from the eyes and controls vision. Specific functions associated with the occipital lobe include complex processing of vision, reading, and relating vision to other sensory experiences.

The Brain Stem

The brain stem is a very important part of the brain because the nerve connections of the motor and sensory systems in the main portion of the brain travel to the rest of the body through the brain stem. It has several critical functions. The brain stem regulates heart and lung functions, such as heart rate and breathing. It also controls the central nervous system and plays a major role maintaining consciousness and regulating the sleep cycle.

In the brain stem, there are many fiber tracts that carry nerve impulses from the brain to the spinal cord. In addition, there are numerous areas of nuclei, which are groups of brain cells that have specialized functions. The diencephalon, pons, midbrain and medulla oblongata make up the brainstem.

Diencephalon: This part of the brain stem includes the thalamus, which relays sensory impulses from one part of the brain to another to be interpreted. Temperature, touch and pain sensation are affected by the thalamus and cortex. The hypothalamus is also located in the diencephalon, and it plays a crucial function in regulating blood pressure, heart rate, body temperature, fluid, sleep cycle and hormones. Optic nerves cross over in the thalamus, so injury here can cause a child to have vision problems.

Pons: The pons connects the medulla oblongata and the thalamus. It transmits information between the cerebrum, medulla oblongata and cerebellum. The pons also plays a major role in the depth and frequency of respiration. An injury to the pons can affect a child’s breathing, ability to close the mouth and chew, vision, hearing, and ability to have coordinated motor function in the head, neck and face.

Midbrain: The midbrain connects the spinal cord and brain stem to the cerebral cortex. It helps control posture, balance, hearing, visual reflexes, hearing, temperature, arousal (alertness), the sleep cycle, and coordinated movement of the head and eyes.

Medulla oblongata: The medulla contains important nuclei that control essential body functions, and it is what connects the brain stem to the rest of the brain. Nerve impulses transmitted up and down the body go through the medulla. It has a cardiac center that controls how fast the heart beats, a respiratory center that helps control breathing and a vasomotor center that affects the dilation or constriction of blood vessel, thereby regulating blood pressure.

Corticospinal tracts: These tracts connect the body to the motor cortex, conducting impulses from the brain to the spinal cord. The corticospinal tracts control the fine motor function of the limbs, such as precise movements of the fingers and toes.

Cellular Functions In The Brain

The brain is comprised of many different types of cells. Neurons carry out the numerous brain functions; these cells process and transmit information through electrical and chemical signals. Neurons connect to each other and are the core of the nervous system. They are also the cells that are the most vulnerable to injury.

Neurons receive information from cells through dendrites and they send information via axons. Dendrites are short fiber branches, while axons are much longer nerve fibers that are lined with myelin, which serve to insulate the fibers. The synapse is the region where electrical / chemical signals are communicated from one cell to another.

The information sent to the neurons from the dendrites is processed by the neuron body. Multiple dendrites can send information a neuron, but in general, there is only one axon per neuron to carry information away. Thus, a lot of information gets bundled when it is sent away via the axon. Sometimes, however, only one nerve impulse arrives, so it gets sent away in a straight shot. Whether there is a bundling or a straight shot of a nerve impulse depends on the function, location, and strength of the impulse as well as the size and shape of the neuron and several other factors.

The cell bodies of neurons are typically located in the gray matter portion of the brain. The axons are part of the white matter, which forms the deeper areas of the brain.

The nucleus is the control center of the cell because it maintains the integrity of the genes and controls the activity of the cell by regulating gene expression. Groups of nuclei usually appear as gray matter and are mixed within the white matter in the brain stem.

If a neuron is damaged so much that the cell dies, it will not regenerate. Injury of an axon may sometimes be repaired, depending on how much damage there is.

There are many different types of cells that help support neuron function, and these include oligodendrocytes, astrocytes, and microglia, which are all a type of glial cell. Glial cells support the function of neurons by supplying oxygen and nutrients, insulating neurons from each other, surrounding and holding neurons in place, destroying harmful agents and removing neurons that have died. In addition, glial cells play an important role in helping with signal transmission.

Long-Term Outlook Effects of Neonatal Brain Injury

Knowing the location of a brain injury can give some information regarding what type of complications a child will face long-term. Of course, the outcome cannot be determined solely based on the assessment of the injury location. Important items to remember include the fact that brain injury is an evolving process. Clinicians recognize the fact that brain injury occurring during or near the time of birth is the most common cause of long-term neurological deficits in a child. When a brain injury is suspected, head imaging is typically performed within 12 – 24 hours of the brain insult. Brain imaging studies must be continuous because an injury can evolve over days, weeks and even months. Examining the evolution of injury as well as the final extent of the damage is very important.

There are many factors that contribute to how a brain injury will affect a child long-term. One factor is early intervention. Physical therapy can be started when a child is just a few months old. Another important treatment is called hypothermia (brain cooling) treatment. Hypothermia treatment has been shown to halt almost every cellular process involved in the progression of brain injury. Brain cooling must take place within 6 hours of the insult that caused the brain injury. Hospitals have criteria the physicians use to determine if a child qualifies for hypothermia treatment. If a child is diagnosed with hypoxic ischemic encephalopathy (HIE), she almost always qualifies for brain cooling therapy. A diagnosis of HIE can be made without brain imaging (although imaging must be performed as soon as possible).

Hypothermia treatment has been shown to reduce the likelihood that a child will develop cerebral palsy after a diagnosis of HIE. It also has been shown to reduce the severity of brain injury and resultant cerebral palsy. The more severe the brain insult, the sooner the brain cooling treatment should be initiated.

Hypothermia treatment is also a treatment for stroke. Research shows that stroke and hypoxic ischemic encephalopathy often occur together.

When children experience a brain injury, hypothermia treatment may prevent lifelong conditions such as cerebral palsy. If the child is diagnosed with cerebral palsy, there are many different types oftreatments and therapies – including a groundbreaking surgery called selective dorsal rhizotomy (SDR)– that can greatly improve a child’s muscle function.

When a child experiences a brain insult, she may later be diagnosed with one or more of the following:

Hypoxic ischemic encephalopathy (HIE)

Cerebral palsy

A seizure disorder

Periventricular leukomalacia (PVL)

Intellectual disabilities and developmental delays

Hydrocephalus

Children with brain injuries can have muscle function, intellectual, perceptual, emotional, attention and language problems. There are treatments and therapies for all of these types of problems. The key is early recognition and intervention.

Signs Of Infant Brain Injury

Seizures are a common sign that a baby has had a brain injury. Sometimes seizures aren’t recognized until an EEG is performed on the baby. Failure to perform frequent or continuous EEGs can result in a brain injury going undetected for a long time, especially since seizure activity is often the only sign of a brain injury. Listed below are some of the signs that a baby has suffered a brain injury.

Signs of brain injury in a baby include the following:

Seizures within the first 24 – 48 hours of delivery

Low Agar scores for more than 5 minutes. An Apgar score assesses the overall health of a newborn over the first few minutes of life. It assigns scores to factors such as the baby’s skin color / complexion, pulse rate, reflexes, muscle tone, and breathing.

Failure to breathe immediately after delivery / the baby needed to be resuscitated

No brain stem reflexes (e.g., breathing problems and an abnormal response to light, and only blood pressure and heart function reflexes are functioning)

Hypotonia (low muscle tone)

When a pregnancy or birth was difficult or a baby experienced an event that could cause oxygen deprivation and / or brain bleeds, the medical team must be on the lookout for signs of a brain injury. When a brain injury is suspected, head imaging and other diagnostic tests can be done so the medical team can pinpoint the type of injury, the cause of the injury and any ongoing processes that can be treated. In addition, if HIE is even remotely suspected in a newborn, the medical team should promptly assess the baby for HIE so that crucial hypothermia treatment can be given, if indicated.

Causes Of Neonatal Brain Injury

Conditions that occur close to or during the time of delivery that can cause oxygen deprivation and brain injury include the following:

Placenta previa

Ruptured uterus (womb)

Preeclampsia / eclampsia

Placental abruption

Umbilical cord problems, such as a nuchal cord (cord wrapped around the baby’s neck),umbilical cord prolapse, short cord, cord in a true knot

Premature rupture of the membranes (PROM) / premature birth

Failure to quickly deliver a baby when fetal distress is evident on the fetal heart rate monitor (delayed emergency C-section)

Oligohydramnios (low amniotic fluid)

Anesthesia mistakes, which can cause blood pressure problems in the mother, including a hypotensive crisis

Prolonged and arrested labor

Stroke in the baby

Intracranial hemorrhages (brain bleeds), which can be caused by a traumatic delivery. Forceps and vacuum extractors can cause brain bleeds. Mismanagement of cephalopelvic disproportion (CPD), abnormal presentations (face or breech presentation), and shoulder dystocia also put a child at risk of having a brain bleed.

Hyperstimulation caused by Pitocin and Cytotec

There are many other injuries that can damage a baby’s brain and cause conditions such as cerebral palsy. This includes:

Improperly treated high bilirubin levels (jaundice) that cause a form of brain damage called kernicterus.

Improperly treated neonatal hypoglycemia (low blood sugar).

Brain infection such as meningitis, which can be caused by infections in the mother that travel to the baby at birth. These maternal infections include the following: Group B Strep (GBS),herpes simplex virus (HSV), urinary tract infection (UTI), bacterial vaginosis (BV) and chorioamnionitis.

Cerebral Palsy and hypoxic ischemic encephalopathy (HIE) are difficult areas of law to pursue due to the complex nature of the disorders and the medical records that support them. The award-winning lawyers at ABC Law Centers have decades of experience with cerebral palsy and HIE cases. We handle cases in California, Pennsylvania, Florida, New York, Michigan, Ohio, Washington, D.C. and throughout the country and we give personal attention to each child and family we help. We have numerous multi-million dollar verdicts and settlements that attest to our success, and no fees are ever paid to our firm until we win your case.